Робин Кук - Vital Signs

“Ask Chi-Li if he sees much tuberculosis,” Marissa asked as she replaced the BCG vial. She glanced at the other contents of the cabinet while Tse spoke with the man.

“He sees about the same as I,” Tse reported.

Marissa closed the cabinet door. “Ask him if he ever sees TB as a female problem,” she asked. She watched Chi-Li’s face as Tse translated. There was always the chance she could hit on something unexpected. But Chi-Li’s expression reflected a negative response to the question. Tse translated that Chi-Li had seen nothing of the kind.

Leaving the procedure room, they walked into an examining room. A female patient was sitting on a chair in the corner. She stood and bowed as the group entered.

Marissa bowed back, sorry to have intruded. Suddenly Marissa stopped. In the center of the room was a relatively modern examining table, complete with stainless steel stirrups.

Seeing the table brought back all the unpleasant procedures she’d endured over the last year in the course of her fertility treatments. She was surprised to see such a modern piece of equipment at the clinic; nearly everything else she’d seen was quite dated and rudimentary.

Stepping over to the table, Marissa absently fingered one of the stirrups. “How did this examining table get here?” she asked.

“The same way all the other equipment got here,” Tse said. “Most of the rural health clinics have such a table.”

Marissa nodded as if she understood. But she didn’t. Of all the pieces of modern equipment to be sent to rural clinics, it seemed strange for them to choose an examining table with stirrups. But having read of the bureaucratic mismanagement problems of Communist governments, she assumed this was just another case in point.

“We use such a table frequently,” Tse said. “Birth control has been given a high priority by the government.”

“I see,” Marissa said. She was about to walk on when she looked back at the table. She was puzzled. “What type of birth control do you favor?” she asked. “Intrauterine devices?”

“No,” Tse said.

“Diaphragms?” Marissa asked, even though she knew they couldn’t use diaphragms since they were too expensive and not effective enough. Yet why a table equipped for internal exams?

“We use sterilization,” Tse said. “After one child the woman is often sterilized. Sometimes we perform sterilization even before the woman has a child if there is a request or if the woman should not have a child.”

Tristan called to Marissa from the next room, but Marissa ignored him. Although she had remembered hearing that sterilization was used for birth-control in the PRC, she hated to hear a doctor speaking so coldly about it. She wondered who got to make the decision of who could bear a child and who couldn’t. The issue offended her feminist sensibilities.

“How do you sterilize these women?” she asked.

“We cannulate the fallopian tubes,” Tse said matter-of-factly.

“Under anesthesia?” Marissa asked.

“No need for anesthesia,” Tse said.

“How can that be?” Marissa asked. She knew that to cannulate the fallopian tubes, the cervix had to be dilated, and dilating the cervix was excruciatingly painful.

“It is easy for us rural doctors,” Tse explained. “We use a very small catheter with a wire guide. It is done by feel. We do not need to see. It is not painful for the patient.”

“Marissa!” Tristan called. He had come back to the threshold of the examining room. “Come out here and see the garden. They grow their own medicines!”

But Marissa waved Tristan away. She stared at Tse, her mind racing. “Can Chi-Li perform this technique as well?” she asked.

“I’m sure,” Tse said. “All rural doctors are taught it.”

“Once you cannulate the fallopian tube,” Marissa said, “what do you use to sterilize?”

“Usually a caustic herbal solution,” Tse said. “It is like a kind of pepper.”

Tristan left the doorway and approached Marissa. “What’s the matter, luv?” he asked. “You look like you’ve just seen a ghost.”

Without saying a word, Marissa hurried back to the procedure room and walked up to the cabinet. She studied the shelf of vaccines.

Tristan followed her, wondering what she was thinking. “Marissa,” he said, as he reached out and grabbed her shoulders, swinging her around to face him. “Are you okay?”

“I’m fine,” Marissa said. “Tristan, I think I just figured it all out. All of a sudden I think I understand — and if I’m right, the truth is much worse than we imagined.”

The health clinic van took the four of them to Shigi and dropped them off at the Shigi bus station. Since there was frequent service to Forshan, they had only a short wait. During the trip, Marissa sat next to Tristan while Bentley sat with Tse.

“I’ve never seen anybody spit more than these Chinese,” Tristan said to make conversation. It was true. At any given moment someone on the bus was either preparing to spit or was in the process of spitting out the window. “What the hell is wrong with these blokes?”

“It’s a national pastime,” Bentley said, hearing Tristan’s comment. “You see it all over China.”

“It’s disgusting,” Tristan said. “It reminds me of that foolish American game of baseball.”

Everyone on the bus seemed to be busy talking except Marissa and Tristan. Tristan had finally given up after Marissa persisted in meeting his every question with only one-word replies. She seemed to be deep in thought.

Suddenly she turned to him. “Do you know the pH indicator phenol red?”

“Vaguely,” Tristan said, surprised by her sudden inquiry.

“When does it turn red?” Marissa asked. “In an acidic or an alkaline solution?”

“I think alkaline,” Tristan said. “In an acid solution it’s clear.”

“I thought so,” Marissa said. Then she lapsed back into silence.

They rode for another mile. Finally, Tristan could no longer contain his curiosity. “What’s with you, Marissa?” he asked.

“Why won’t you tell me what you’re thinking?”

“I will,” Marissa said. “But not yet. We have to get out of the PRC. There are a couple of things I have to check to be sure first.”

From Forshan they were able to get hard seats on a train to Guangzhou. Bentley and Tse left them at the Forshan bus station.

By the time they got to Guangzhou it was dark. They took a taxi from the train station. On the recommendation of the driver, they went to the White Swan Hotel. During the short trip both Marissa and Tristan remarked that the city looked more Western than they’d expected, although even at night the bicycles far outnumbered the motor vehicles in the streets.

The hotel turned out to be a surprise as well. The lobby was impressive, with a waterfall. The rooms had all the modern conveniences, including TVs, refrigerators and, more importantly, direct-dial telephones. They booked a suite with two bedrooms and a view over the Pearl River.

Marissa was exhausted. She eyed the bed with longing, hoping that she would at last get a good night’s rest. But even before bed, what she was interested in most was the telephone. After calculating the time on the East Coast of the United States, she decided to put off her call for a few hours. She knew it wouldn’t help to wake Cyrill Dubchek from his sleep.

“They have a Western-style restaurant,” Tristan said with excitement, coming into Marissa’s bedroom with the hotel directory in his hand. “What do you say to a nice big steak!”

Marissa wasn’t hungry, but she accompanied Tristan, who polished off a sizable slab of meat and a number of beers. Marissa ordered a chicken dish, but she hardly touched it except to move it around her plate. They talked about going to the consulate in the morning with the story that they had hired a junk to take them to Guangzhou but that the captain had taken their money and forced them to jump off the boat.